A wide variety of implantable medical devices (IMDs) for delivering a therapy or monitoring a physiological condition have been used clinically or proposed for clinical use in patients. Examples include IMDs that deliver therapy to and/or monitor conditions associated with the heart, muscle, nerve, brain, stomach or other tissue. Some therapies include the delivery of electrical stimulation to such tissues. Some IMDs may employ electrodes for the delivery of therapeutic electrical signals to such organs or tissues, electrodes for sensing intrinsic electrical signals within the patient, which may be generated by such organs or tissue, and/or other sensors for sensing physiological parameters of a patient.
Implantable cardioverter defibrillators, for example, may be used to deliver high energy anti-tachyarrhythmia shocks, e.g., defibrillation shocks and/or cardioversion shocks, to a patient's heart when atrial or ventricular tachyarrhythmia, e.g., tachycardia or fibrillation, is detected. An implantable cardioverter defibrillator (ICD) may detect a tachyarrhythmia based on an analysis of a cardiac electrogram sensed via electrodes, and may deliver anti-tachyarrhythmia shocks via electrodes. An implantable cardiac pacemaker, as another example, may provide cardiac pacing therapy to the heart when the natural pacemaker and/or conduction system of the heart fails to provide synchronized atrial and ventricular contractions at rates and intervals sufficient to sustain healthy patient function. Implantable cardiac pacemakers may also provide overdrive cardiac pacing, referred to as anti-tachycardia pacing (ATP), to suppress or convert detected tachyarrhythmias. Implanted cardiac pacemakers may sense a cardiac electrogram and deliver cardiac pacing pulses via electrodes.
Some IMDs are coupled to one or more of the electrodes used to sense electrical physiological signals and deliver electrical stimulation via one or more leads, which allow the IMD housing to be positioned a desired distance from the target site for sensing or stimulation delivery. For example, a subcutaneously or sub-muscularly implanted housing of an ICD or implantable cardiac pacemaker may be coupled to endocardial electrodes via leads. Other ICDs, referred to as extravascular ICDs, are not coupled to any endocardial electrodes, and instead sense and deliver shocks via a plurality of electrodes, e.g., implanted subcutaneously or substernally, which may be provided by the housing of the subcutaneous ICD and/or coupled to the housing via one or more leads.
Leadless IMDs may also be used to deliver therapy to a patient, and/or sense physiological parameters of a patient. In some examples, a leadless IMD may include one or more electrodes on its outer housing to deliver therapeutic electrical stimulation to patient, and/or sense intrinsic electrical signals of patient. For example, a leadless pacing device (LPD) may be used to sense intrinsic depolarizations or other physiological parameters of the heart, and/or deliver therapeutic electrical stimulation to the heart. LPDs may be positioned within or outside of the heart and, in some examples, may be anchored to a wall of the heart via a fixation mechanism.
In some situations, two or more IMDs are implanted within a single patient. For example, as an alternative to an ICD with cardiac pacing capabilities coupled to endocardial electrodes via transvenous leads, it has been proposed to implant an extravascular ICD capable of delivering anti-tachyarrhythmia shocks, and a separate LPD capable of providing cardiac pacing. In some situations, it may be desirable for the two or more IMDs to be able to communicate with each other, e.g., to coordinate, or cooperatively provide, sensing and/or therapy delivery. For example, it may be desirable to allow an extravascular ICD and LPD to communicate to coordinate delivery of ATP and anti-tachyarrhythmia shocks in response to a tachyarrhythmia detected by one or both of the IMDs. Although some IMDs communicate with external devices, e.g., programming devices, using radio-frequency (RF) telemetry, it has also been proposed to use tissue conduction communication (TCC) for communication between an IMD and an external device, or between an IMD and another IMD.